| NPI | 1063229425 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELSEY ROPER Office Administrator 844-365-2202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2024-12-18 |